Procedural Strategies to Reduce the Incidence of Contrast-Induced Acute Kidney Injury During Percutaneous Coronary Intervention

Marcel Almendarez, Hitinder S. Gurm, José Mariani, Matteo Montorfano, Emmanouil S. Brilakis, Roxana Mehran, Lorenzo Azzalini

Research output: Contribution to journalReview articlepeer-review

87 Scopus citations


Contrast-induced acute kidney injury (CI-AKI) is a potentially serious complication following coronary angiography and percutaneous coronary intervention (PCI). The incidence of CI-AKI is particularly high in patients with advanced chronic kidney disease (defined as an estimated glomerular filtration rate <30 ml/min/1.73 m2). Although much effort has been dedicated to the identification and implementation of preventive measures for this complication at the pre-intervention stage, much less has been investigated on the procedural strategies and techniques to decrease the risk of CI-AKI during PCI. The mainstay of such approaches relies on the minimization of contrast volume by means of specific strategies or dedicated devices. Invasive imaging, such as intravascular ultrasound or non–contrast-based optical coherence tomography, is another pillar of any ultra-low-contrast-volume PCI protocol. Finally, an array of miscellaneous ancillary measures can be implemented to decrease the risk of CI-AKI, which includes the use of radial access, remote ischemic conditioning, and hemodynamic support in high-risk patients. The present review analyzes the technical aspects as well as the scientific evidence supporting these novel techniques, with the goal to improve the outcomes of patients at high risk for CI-AKI undergoing PCI.

Original languageEnglish
Pages (from-to)1877-1888
Number of pages12
JournalJACC: Cardiovascular Interventions
Issue number19
StatePublished - 14 Oct 2019


  • chronic kidney disease
  • contrast-induced acute kidney injury
  • contrast-induced nephropathy
  • intravascular ultrasound
  • optical coherence tomography
  • percutaneous coronary intervention


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